Psychiatric comorbidity in childhood and adolescence headache

The relationship of depressive symptoms with pain and analgesic use in Turkish adolescents

PROBLEM

This study aimed to determine the prevalence of depressive symptoms, pain (headache, abdominal pain, back pain) and analgesic use among Turkish adolescents. Additionally, it aimed to examine the association between depressive symptoms and pain and analgesic use in adolescents.

METHODS

This cross-sectional, correlational study was conducted in Izmir, Turkey with 954 adolescents aged 11-19 years. Data were collected with the "socio-demographic questionnaires" and the "Center for Epidemiologic Studies Depression Scale for Children". Analyzes were performed using descriptive statistics and multiple logistic regression analysis.

FINDINGS

Of the adolescents, 632 (66.2%) showed depressive symptoms. Of the adolescents, 424 (44.4%) experienced headache, 256 (26.8%) experienced abdominal pain, and 343 (36.0%) experienced back pain. A total of 309 (32.4%) adolescents used analgesics for headaches, 132 (13.8%) abdominal pain, and 47 (4.9%) for back pain. Female gender, high level maternal education, bad economic status, poor health perception, bad school success, pain and analgesic use were the correlated variables with adolescent depression.

CONCLUSIONS

The depressive symptoms, headache and back pain, and use of analgesics especially for headaches were common among adolescents. The results showed depression in adolescent correlated with pain (headache, abdominal pain, and back pain) and analgesic use. Regular screening is needed to assure early intervention of depression among adolescents.

Tension-Type Headache in Children and Adolescents

In pediatric neurology, tension-type headache (TTH) represents a very common type of primary headache during the pediatric age. Despite the high prevalence of TTH, this diagnosis is often underestimated in childhood, with relevant difficulties in the differential diagnosis of TTH from secondary and primary headache manifestations. Even among primary headaches, a clinical overlap is not so infrequent in children: migraine attacks could present tension headache-like features while tension-type headaches may display migraine-like symptoms as well. Several variables play a role in the complex trajectory of headache evolution, such as hormonal changes during adolescence, triggers and genetic and epigenetic factors. The trajectories and outcomes of juvenile migraine and TTH, as well as the transition of one form to the other, have been investigated in several long-term prospective studies. Thus, the aim of this paper is to review the current literature on the differential diagnosis workout of TTH in pediatrics, the possible outcomes during the developmental age and the appropriate therapeutic strategies. Indeed, TTH represents a challenging diagnostic entity in pediatrics, both from a clinical and a therapeutic point of view, in which early diagnosis and appropriate treatment are recommended.

Interpersonal violence and recurrent headache among adolescents with a history of psychiatric problems

BACKGROUND

Interpersonal violence (IPV) is found to be associated with mental health problems and pain disorders such as headache among children and adolescents. It is well-known that adolescents in need of mental health services have experienced IPV more often than adolescents in the general population. However, there has not been much focus on pain conditions in child and adolescent psychiatric populations.

METHODS

Data from the current study are based on a 3-year follow-up of the CAP-survey, which is a study of adolescents in the child and adolescent psychiatric unit population of St. Olavs Hospital (Trondheim University Hospital). The baseline study was conducted between 2009 and 2011, with 717 participants between 13 and 18 years. All participants were enrolled, or newly referred to the child and adolescent psychiatric clinic. At follow-up, 570 participants completed questionnaire, and 550 completed a diagnostic interview. The participants were aged 16-21 years (mean age 18.6 years).

RESULTS

A third of the adolescents reported frequent headaches (weekly or daily). Adolescents with more severe mental problems were more likely to experience frequent headaches. Adolescents exposed to unpleasant sexual acts or bullying, reported more frequent headaches than non-exposed participants. Participants exposed to three or more types of IPV seemed to be at particularly high risk of experiencing frequent headache.

CONCLUSIONS

Both experiences of interpersonal violence and headache are common in this clinical psychiatric population. Clinicians should assess for headache disorders in addition to psychiatric and trauma assessment and provide need-based treatment to enhance chance of recovery among adolescents in mental health services.

Association of anxiety and depression to headache, abdominal- and musculoskeletal pain in children

The comorbidity between recurrent pain, anxiety, and depression among children is frequent and well documented. However, only a few studies of the predictive effect of anxiety and depression on pain have adjusted for symptoms of the other disorder when examining the respective relations to different pain locations, rendering the unique contribution from anxiety and depression undetermined. In the current investigation we explore the strength of associations between pain at different locations with symptoms of anxiety and depression in a community sample of 10-year-old children (n = 703). The children were interviewed about the frequency of pain during the last 3 months. Parents and children were interviewed separately about symptoms of anxiety and depression using a semi-structured diagnostic interview. Results of three multivariate regression models for each of headache, abdominal and musculoskeletal pain revealed that depression was associated with musculoskeletal pain and headache, whereas anxiety was not. The associations for depression were not significantly stronger compared to anxiety. Gender-specific models found that depression was related to headache only among girls, but the association was not statistically different compared to boys. These results may, in turn, influence our interpretation of different forms of pain in children, with less weight given to abdominal symptoms viewed as a strong correlate with psychological problems, compared to for instance headache. The results provided no clear support for neither a differential relationship between anxiety and pain and depression and pain nor gender differences.

Psychological Disorders, Adverse Childhood Experiences and Parental Psychiatric Disorders in Children Affected by Headache: A Systematic Review

BACKGROUND

Pediatric headaches have been linked to adverse life events or psychological factors in children and their families, with a complex and bidirectional association. Moreover, it is well-known that psychological stress can trigger headaches.

METHODS

We searched three databases for studies focusing on headaches and adverse events or psychological factors in children up to 12 years old or in their caregivers.

RESULTS

We included 28 studies. Child psychological factors, including internal and external symptoms, were commonly associated with all types of headaches. Sleep disturbances showed a positive association with headaches in 3 out of 5 studies. Family conflict and unhappiness were frequently found in children suffering with headaches, while single-parent families and divorce were not associated. Stressful environments and adverse life events, particularly bullying, were also found to be linked with headaches.

CONCLUSIONS

Childhood headaches represent an alarm bell for clinicians to investigate and treat psychological or psychiatric disorders in children and their family. Further studies are needed to elucidate the role of early-life adverse events in children and their families.

Headache in girls and boys growing up from age 11 to 20 years: the Prevention and Incidence of Asthma and Mite Allergy birth cohort study

ABSTRACT

The striking difference between men and women in headache prevalence is suggested to develop in adolescence. Although headaches are common and affect quality of life and daily functioning, the evidence needed to develop effective counselling and preventive approaches is still limited. Using data collected at age 11, 14, 17, and 20 years in the Dutch Prevention and Incidence of Asthma and Mite Allergy birth cohort study (n = 3064 with ≥ 1 questionnaire), we assessed headache prevalence and incidence in girls and boys and explored associations with early life, environmental, lifestyle, health, and psychosocial factors. Associations were analysed longitudinally with generalized linear mixed models and discrete time hazard models. From age 11 to 20 years, the prevalence of headache increased from 9.4% to 19.8% in girls and hardly changed in boys (7.6%-6.1%). Headache commonly co-occurred with other unfavorable health and psychosocial conditions. Eighty-eight percent of the girls and 76% of boys with headache also reported at least one of the following at age 17: sleeping problems, asthma, hay fever, musculoskeletal complaints, fatigue, low mental health, or worrying. Results suggest higher headache prevalence in adolescents following lower educational tracks, in those who skip breakfast ≥2 days per week, and in boys exposed to tobacco smoke in infancy. In girls, sleeping problems and musculoskeletal complaints were associated with higher odds of incident headache and residential greenness with lower odds of incident headache. The high prevalence and strong female predominance of headache, already in adolescence and often with comorbidities, deserve recognition by professionals in (preventive) health care settings and schools.

Migraine and Mood in Children

Migraine is one of the most prevalent headache disorders in children and negatively influences their quality of life. Physical, social, and school functioning are negatively affected. Mood changes are common in migraineurs and may happen before, during, or after a migraine headache. Children with migraine are not exempt from mood swings. The majority of mood changes occur during the prodromal phase, manifesting as a psychobiological response, e.g., difficulty thinking, trouble concentrating, irritability, higher or lower energy, confusion, and depression. A bi-directional relationship between migraine and mood has been proposed, but mechanisms are not clear. Collectively, a maladaptive stress response has been suggested to explain the inability to balance homoeostatic changes when facing various stressors. Recognizing mood changes and monitoring mood patterns in children with migraine, for example, by various apps and so-called mood monitors, is valuable for better management. A multidisciplinary intervention has been recommended to reduce migraine disability, improve coping strategies, and reduce chronification risks in children with migraine. Pharmacological and non-pharmacological strategies are both available and effective. Biofeedback, relaxation, and cognitive-behavioral therapy yield positive outcomes in pediatric migraine. Developing healthy lifestyle habits (diet, exercise, sleep) also seems to improve migraine in this population.

Comparison of Children with Migraine and Those with Tension-Type Headache for Psychiatric Symptoms and Quality of Life

This study compared the severity of depression, anxiety, somatization, anxiety sensitivity, sleep disturbances, and quality of life (QoL) among children with migraine, children with tension-type headache (TTH), and healthy children. A total of 37 children with migraine, 22 with TTH, and a healthy control group (n = 35) participated in this study. Children with migraine exhibited higher depression and somatization and lower QoL scores than those in the control group. General sleep disturbances, bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, sleep-disordered breathing, and daytime sleepiness scores were also higher in those in the migraine group than in the control group. Regression models indicated that the severity of headache and depression scores significantly affected the QoLs of children with headache disorder as a whole. Migraine is associated with depression, somatization, sleep disturbances, and poor QoL, whereas TTH is associated with only sleep disturbances in childhood. The impact of headache on the QoL occurs mainly through the headache-specific and psychiatric factors.

Early Pain and Other Somatic Symptoms Predict Posttraumatic Stress Reactions in Survivors of Terrorist Attacks: The Longitudinal Utøya Cohort Study

Survivors of traumatic events commonly suffer from long-term pain and related somatic symptomatology. To test the predominant hypothesis that survivors' pain comprises sequela of persistent posttraumatic stress symptoms (PTSS), we assessed the sequential order of symptom development among young survivors of a terrorist attack. All 490 survivors of the 2011 Utøya (Norway) attacks were invited to the longitudinal Utøya cohort study; 355 (72.4%) participated. The mean survivor age was 19.3 years (SD = 4.6) and 169 were female (47.6%). Somatic symptoms, including headache, other pain and fatigue, and PTSS, were measured 4-5 months (T1), 14-16 months (T2), and 32-33 months (T3) after the attack. Longitudinal associations between somatic symptoms and PTSS were assessed in cross-lagged structural equation model (SEM) analyses, which were adjusted for known confounders. Higher pain levels and other somatic symptoms at T1 consistently predicted PTSS at T2 in SEM analyses, r = .473, p < .001. Beyond this early-to-intermediate posttraumatic phase, somatic symptoms did not significantly predict PTSS: T2-T3, r = .024, p = .831; T1-T3, r = -.074, p = .586. PTSS did not significantly predict later somatic symptomatology at T1-T2, r = .093, p = .455; T2-T3, r = .272, p = .234; or T1-T3, r = -.279, p = .077. The findings indicate that survivors' early pain and related somatic symptoms strongly and consistently predict later psychopathology. After severe psychological trauma, early interventions may need to address individuals' pain to hinder chronification.

The ALPIM (Anxiety, Laxity, Pain, Immune, and Mood) Syndrome in Adolescents and Young Adults: A Cohort Study

OBJECTIVE

ALPIM (anxiety, laxity, pain, immune, and mood) syndrome has been previously described in adults. The authors aimed to identify its occurrence in adolescents and confirm its existence in adults. Given the association of the disorder with somatic symptoms, separation anxiety disorder (SAD) was explored as an ALPIM comorbidity.

METHODS

Medical records of patients aged 11-34 with a diagnosis of depression or anxiety (panic disorder, SAD, social anxiety or generalized anxiety disorder) seen during a 1-year period were reviewed. Data were collected on the presence of ALPIM comorbidities. Analyses were conducted to detect their co-occurrence and evaluate possible predictors of the ALPIM syndrome.

RESULTS

Inclusion criteria were met by 185 patient charts. A significant association was observed between the ALPIM comorbidities with 20 study subjects (10.8%) meeting criteria for ALPIM syndrome (patients with one or more diagnoses from each ALPIM domain). Patients with SAD had increased odds of being diagnosed with ALPIM (odds ratio=7.14, 95% CI=2.48-20.54, p<0.001). Neither major depression nor generalized anxiety disorder was found to be predictive of ALPIM syndrome. There was no difference in the prevalence of ALPIM-related comorbidities between study subjects <18 years old compared with those ≥18 years old.

CONCLUSIONS

These findings reestablish the association of distinct psychiatric and nonpsychiatric conditions described as the ALPIM syndrome. Furthermore, the syndrome may present during adolescence. SAD may be an independent predictive factor for the occurrence of ALPIM syndrome. Patients with individual ALPIM comorbidities should be assessed for the syndrome, especially if they have a history of SAD.

Bullying, pain and analgesic use in school-age children

AIM

The aim of this study was to examine whether the self-reported use of analgesics is associated with being a victim of bullying.

METHODS

This cross-sectional, school-based survey included all students in grades 6 (11 years old), 8 (13 years old) and 10 (15 years old) in Iceland (response rate: 84%; n = 11 018). The students filled out an anonymous standardised questionnaire: the Icelandic Contribution to the International Health Behavior in School-Aged Children (HBSC) Study.

RESULTS

Being bullied was associated with increased use of analgesics even after controlling for self-reported pain.

CONCLUSION

Bullying occurs in all schools, and its effects on health are pervasive. Interventions aimed at reducing bullying and promoting health in schools are important and may reduce the use of analgesics in adolescents.

Alexithymia, Metacognition, and Theory of Mind in Children and Preadolescents With Migraine Without Aura (MWoA): A Case-Control Study

Background: Some studies have demonstrated the high impact of headache and migraine in several areas of children and adolescents' life. In recent years, there has been an increase in scientific interest in the relationship between migraine and emotional regulation, investigating the possible consequences of emotional dysregulation on physical and mental health. While some studies have been carried out on the relationship between alexithymia and headache or migraine (especially in adults), no data exist on relationship between Theory of Mind (TOM), metacognition, and alexithymia in children and adolescents with migraine. Methods: Children with diagnosis of migraine without aura (MWoA) (36 males and 34 females) were compared to a healthy control group (31 males and 39 females). The age range was from 8 to 13 years in both groups. All children completed the Alexithymia Questionnaire for Children (AQC) for the assessment of alexithymia levels and the Domain of Social Perception included in the NEPSY-II to evaluate levels of TOM. Metacognitive development was evaluated with Io e La Mia Mente for children aged between 8 and 10 years and with Metacognitions Questionnaire for Children (MCQ-C) for children from 11 to 13. Results: There were no differences between children with MWoA and the control group in metacognitive abilities; only in the subscale "Negative Meta Worrying" of MCQ-C girls scored higher than boys, regardless of the group they were part of. Also, in the NEPSY-II subscale there were no statistically significant differences between the two groups. Children with MWoA scored higher in the AQC subscales "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" than controls. Moreover, children between 8 and 10 years statistically differed from older children in "Difficulty Identifying Feelings" and in Total Score. Conclusion: Our data suggest that children with MWoA have no metacognitive and TOM problems compared to a healthy group. The experimental group showed higher traits of alexithymia, confirming what suggested by other studies in the literature. Future research will have to focus on migraine with aura and tension-type headache to evaluate any differences with children with MWoA.

Improving the Patient Experience With Migraine Camp, a One-Day Group Intervention for Adolescents With Chronic Headache and Their Parents

Though chronic migraine is actually common in adolescents, living with constant headache can be isolating for both patients and their families. As an outgrowth of clinical care, we developed the Miles for Migraine Youth Camp, a recurring 1-day event for adolescents with chronic headache and their parents. Migraine Camp was developed to provide expanded headache education, teach coping strategies for living with chronic pain, and encourage development of a supportive community for adolescents living with chronic headache disorders and their families. The creation and curriculum of the Camps at the University of California San Francisco and Children's Hospital of Philadelphia are described in this manuscript, along with patient and caregiver feedback. Overall, feedback was positive. Teens reported feeling less isolated and more prepared to cope with headaches using new strategies. Both patients and caregivers consistently described benefit from connecting with others who experience similar challenges. The Migraine Camp teams at both institutions found it feasible to conduct the Camps 1-2 times per year using existing resources, but noted that to scale it to a more regular event additional administrative and/or volunteer support would be needed. In summary, the experience has been positive for patients, caregivers, and staff, and we hope that this manuscript can serve as a "how to" model for similar events at other institutions.

Somatic health and its association with negative psychosocial factors in a sample of Moroccan adolescents

Background:

Adolescence is a distinct developmental phase characterized by multiple physical and psychological changes and by an increased vulnerability to somatic and mental health problems. These risk and vulnerability factors are part of a complex biopsychosocial matrix, encompassing multiple factors, such as inherited biological determinants and psychological, societal, and cultural influences, which affect an adolescent’s overall wellbeing. In Morocco, similar to other developing countries, adolescents (young people aged from 15 to 19 years) constitute a substantial proportion of the population (almost 9%). However, studies about adolescents’ health in developing countries are scarce. In this study, we describe adolescents’ somatic health in a sample of high school students from the city of Tetouan, Morocco, and investigate how negative psychosocial factors, such as parental alcohol use problems and/or the experience of abuse, may influence them.

Methods:

The study sample included 655 adolescents (315 boys and 340 girls, M = 16.64 years, range = 15–18 years) from conviniently selected classes of four high schools in the city of Tetouan in Morocco. The students responded to a survey that assessed the prevalence of somatic complaints/disorders. They also indicated whether they had ever experienced physical and/or psychological abuse and whether they had parents with alcohol use problems.

Results:

More than half of the adolescents suffered from headaches and one-third had substantial problems with diarrhea or constipation. Both problems were more common in female students. The third most frequent somatic problem, affecting one in four in both genders, was allergy. Almost one-third of Moroccan adolescents (significantly more boys than girls; p = 0.004) reported no somatic complaints. In adolescents who reported parental alcohol use problems and/or experience of physical and/or psychological abuse, the prevalence of several somatic complaints (epilepsy, migraine, headache, diarrhea/constipation, gluten intolerance, allergy, and skin or thyroid disease) increased highly significantly compared to the adolescents who reported no such psychosocial environmental factors.

Conclusion:

The results suggest that only 3 in 10 urban-living Moroccan adolescents are free of somatic complaints, while the majority suffer from some somatic problems, most often headaches and diarrhea/constipation. The association of certain negative psychosocial factors with adolescents’ somatic health suggests the need of a holistic approach to the treatment of affected adolescents.

Guidelines of the International Headache Society for controlled trials of preventive treatment of migraine in children and adolescents, 1st edition

Background

Because the results of clinical trials of investigational treatments influence regulatory policy, prescribing patterns, and use in clinical practice, high quality trials are an essential component of the evidence base for migraine. The International Headache Society has published guidelines for clinical trials in adults with migraine since 1991. With multiple issues specific to children and adolescents with migraine, as well as the emergence of novel trial designs and advances in pharmaceuticals, biologics, devices, and behavioural interventions, there is a need for guidance focusing on issues specific to the conduct of clinical trials in children and adolescents with migraine.

Objectives

The objective of these guidelines is to provide a contemporary, standardized, and evidence-based approach to the design, conduct, and reporting of well-controlled clinical trials of preventive treatment of migraine in children and adolescents.

Methods

The development of these guidelines was based on guidelines previously published by the International Headache Society and regulatory bodies. The recommendations are evidence-based, where available. The process included consultations among various committees, roundtable discussions among stakeholders (lay people and the pharmaceutical industry), and open consultation with the IHS membership on the final draft.

Results

A series of recommendations addressing the major issues in clinical trials in children and adolescents with migraine is provided. Recommendations are supported by evidence-based practice and validated methodologies, where available. Supporting comments are provided to clarify ambiguities.

Conclusions

These guidelines should be consulted and used in designing and conducting clinical trials of preventive treatments in children and adolescents with migraine.

Association of Depressive Symptoms with Consumption of Analgesics among Adolescents

PURPOSE

To investigate the prevalence of depressive symptoms, pain (headaches and stomachaches), and analgesic consumption in addition to the association between depressive symptoms and analgesic consumption among adolescents.

DESIGN AND METHODS

This cross-sectional study was conducted in southern Sweden. The survey was distributed among students in grade 8 (aged 13-15 years, n = 878).

RESULTS

The prevalence of depressive symptoms (Center for Epidemiological Studies Depression Scale ≥16) was 37% among girls and 13% among boys. The prevalence rate of analgesic consumption to ease headaches and/or stomachaches during the last several weeks was 57% among girls and 29% among boys. Depressive symptoms are significantly associated with analgesic consumption among adolescents even after controlling for pain.

CONCLUSION

The knowledge that there is a higher use of analgesics in adolescents with depressive symptoms implies that healthcare professionals should focus on complex psychosocial problems, not only physiological pain, in adolescents.

PRACTICE IMPLICATIONS

Over the counter analgesics are frequently used by adolescents. Head and stomachaches are common reasons for students to visit the school nurse and primary healthcare facility. School nurses and pediatric nurses have to be aware of the link between depressive symptoms and pain in addition to the higher use of analgesics in adolescents with depressive symptoms. It is important to reduce the cause of the pain in order to prevent depressive symptoms and also analgesic overuse.

HEADACHES IN ADOLESCENTS - FREQUENCY, RISK FACTORS AND OTHER HEALTH COMPLAINTS: A CROSS-SECTIONAL STUDY IN CROATIA

SUMMARY – Headaches are very common in school population. The aim of this study was to determine epidemiological data on headaches among Croatian schoolchildren and their connection to risk factors and other health complaints. In the study, we used the Croatian database of the international research entitled Health Behavior in School-aged Children for 2013/2014. It is a cross-sectional study conducted every four years in 44 countries among children aged 11-16. The students were interviewed using an anonymous standardized questionnaire. The Croatian sample consisted of 5741 students, of which 2857(49.8%) girls and 2884 (50.2%) boys. The response rate was 85.9%. Headaches were reported to be often (once a week to daily) by 23.5% of students and were more often in girls and in higher school grades. They were positively linked to cigarette smoking and health complaints such as back pain and stomachache, bad mood, nervousness, irritability, difficulties with sleeping and dizziness. Headaches are associated to many health problems and can cause difficulties in student functioning. This could be a serious problem. This study pointed to connection of headaches with cigarette smoking and importance to underpin the smoking prevention programs.

The Relationship Between Reported Pain and Depressive Symptoms Among Adolescents

Pain and depressive symptoms are common reasons for adolescents to contact the school nurse. The aim was to describe the prevalence of pain (headache, abdominal pain, and back pain) and depressive symptoms among adolescents and to examine whether there is an association between pain and depressive symptoms. This cross-sectional survey included students (N = 639) in Sweden (median age: 16 years). Over half of the female participants (56%) and one third of male participants (33%) had weekly headaches, abdominal pain, or back pain. Almost every second girl (48%) and one in four boys (25%) had depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale, scores ≥ 16). There was a significant association between having pain (headache, abdominal pain, or back pain) and having depressive symptoms. It is of great importance for school nurses to adequately identify and treat the cause of pain and other factors contributing to depression.

The causal role of smoking on the risk of headache. A Mendelian randomization analysis in the HUNT study

BACKGROUND AND PURPOSE

Headache has been associated with various lifestyle and psychosocial factors, one of which is smoking. The aim of the present study was to investigate whether the association between smoking intensity and headache is likely to be causal.

METHOD

A total of 58 316 participants from the Nord-Trøndelag Health (HUNT) study with information on headache status were genotyped for the rs1051730 C>T single-nucleotide polymorphism (SNP). The SNP was used as an instrument for smoking intensity in a Mendelian randomization analysis. The association between rs1051730 T alleles and headache was estimated by odds ratios with 95% confidence intervals. Additionally, the association between the SNP and migraine or non-migrainous headache versus no headache was investigated. All analyses were adjusted for age and sex.

RESULTS

There was no strong evidence that the rs1051730 T allele was associated with headache in ever smokers (odds ratio 0.99, 95% confidence interval 0.95-1.02). Similarly, there was no association between the rs1051730 T allele and migraine or non-migrainous headache versus no headache.

CONCLUSION

The findings from this study do not support that there is a strong causal relationship between smoking intensity and any type of headache. Larger Mendelian randomization studies are required to examine whether higher smoking quantity can lead to a moderate increase in the risk of headache subtypes.

Clinical characteristics of headache in Italian adolescents aged 11-16 years: a cross-sectional questionnaire school-based study

Background

The purpose of this study was to determine headache characteristics, impact on daily activities and medication attitudes among a large sample of adolescents in Italy.

Methods

Secondary school classes were randomly selected from a national stratified multistage sampling. Data regarding socio-familial factors, headache characteristics, impact on daily activities and medication use were recorded with an anonymous multiple-choice questionnaire.

Results

The survey involved 2064 adolescents. 1950 questionnaires were considered for analysis. Study population included 944 males (48.4%) and 1006 females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1 hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was moderate in 52.2% and severe in 9.5%. School represented the main trigger factor (67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents reported the use of pain relievers. Up to 5.7% declared self-medication, while only 20.6% followed a physician’s prescription. Female adolescents experienced headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls had a higher family history of headache, could more frequently identify a trigger factor, and were more affected into their daily activities than boys.

Conclusions

Population-based studies of headache disorders are important, as they inform needs assessment and underpin service policy for a disease that is a public-health priority. Headache has a high prevalence among adolescents and carries a significant burden in terms of impact on daily activities and use of medication. Furthermore, underdiagnose is common, while trigger factors are often detectable. Special consideration should be given to female adolescents and self-medication attitudes.

Stress management for headaches in children and adolescents: A review and practical recommendations for health promotion programs and well-being

Stress is considered to be the most common factor reported to trigger headaches in children and adolescents. Although tension-type headache and migraine are the two most common types of headache in children and adolescents, they are often untreated, ignoring their stressful background. We provide a narrative review of the available evidence for health-care professionals involved in stress-related headache management and health promotion programs. An integrative plan is delivered through lifestyle improvement and biopsychosocial modifying stress response techniques. Healthy dietary choices, sleep hygiene, and regular exercise, although limited, are effective for young sufferers. Biopsychosocial therapies such as relaxation, biofeedback, hypnosis, yoga, cognitive behavioral therapy, and acupuncture focus at stress physiological and behavioral relief. Our purpose is to suggest a stress-related headache management to empower children to make healthy choices in order to improve their lifelong well-being and quality of life. We aim to authorize relationship between nurses and other health-care providers with background knowledge around stress management for pediatric headache populations.

Headache and Alexithymia in Children and Adolescents: What Is the Connection?

Background: Headache is one of the most common complaints in children and adolescents and comorbidity rates are very high and the major associated diseases are depression, anxiety, atopic disorders, sleep, and behavioral disorders. In recent years, it has been highlighted that difficulties regulating emotions such as alexithymia have also been associated with diagnosis of somatization. Methods: We carried out a mini review analyzing the relation between alexithymia and primary headache (e.g., migraine and tension type headache) in children and adolescents by synthesizing the relevant studies in the literature on PubMed, PsycINFO, and Google Scholar. Search terms were "alexithymia" combined with the "primary headache," "migraine," "tension type headache," "children," and "adolescents." Results: All analyzed studies found higher levels of alexithymia in children and adolescents with headache than control groups but there are different opinions about the relationship between headache and alexithymia. For example, some studies suggest that the association between headache and alexithymia in children may be due to an incomplete development of emotive competency or a general immature cognitive development, instead other studies found a correlation between headache symptoms, insecure attachment, and alexithymia. There seems to be also differences between children with migraine compared to those with tension type headache (TTH). Conclusion: There are some studies on adults suffering from headache or migraine and alexithymia, but there is only a moderate amount of research on pediatric age with different opinions and theories about this relationship. Further studies on children and adolescents are necessary to effectively understand this relationship and to help children to reduce headache and improve emotional consciousness.

Metacognition and Headache: Which Is the Role in Childhood and Adolescence?

Headache, in particular migraine, is one of the most frequent neurological symptoms in children and adolescents and it affects about 60% of children and adolescents all over the world. Headache can affect several areas of child’s functioning, such as school, physical activities, peer, and family relationship. The global and severe burden of this disease requires a multidisciplinary strategy and an effective treatment addressed all of the patient’s needs and based on cutting-edge scientific research. In recent years, research has focused on cognitive factors specifically in functions called metacognitive processes. Metacognition can be defined as the knowledge, beliefs, and cognitive processes involved in monitoring, control, and assessment of cognition. Metacognition seems to be closely related to the ability of theory of mind, the ability to infer, and reason about the mental states of other people in order to predict and explain own behavior. Recent studies found a relationship between metacognitive skills and anxiety, depression, motivation, academic performance, human social interactions, and stress symptoms. This relationship is very interesting for headache treatment, because these factors are the most commonly reported triggers in this disorder and there is a high comorbidity with anxiety and depression in children and adolescents with headache. So, headache and these comorbidities, in particular anxiety and depression, may have in common persistent and maladaptive patterns of thinking which are related to maladaptive metacognitive beliefs. Further research should assess metacognitive processes of children and adolescents with headache in order to increase their ability to control their own cognitive processes and consequently monitor factors which may trigger the attacks.

The effect of foetal growth restriction on the development of migraine and tension-type headache in adulthood. The HUNT Study

BACKGROUND

There is little knowledge about how factors early in life affect the development of migraine and tension-type headache. We aimed to examine whether growth restriction in utero is associated with development of migraine and frequent tension-type headache in adults.

METHODS

The population-based Nord-Trøndelag Health Study (HUNT 3) contained a validated headache questionnaire, which differentiated between migraine and tension-type headache. These data were linked to information on weight and gestational age at birth from the Norwegian Medical Birth Registry. In total 4557 females and 2789 males, aged 19-41 years, were included in this registry-based study. Participants were categorized as appropriate for gestational age (AGA, 10th-90th percentile), small for gestational age (SGA, 3rd-10th percentile) or very small for gestational age (VSGA, < 3rd percentile). Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for migraine and tension-type headache, with exposure being growth restriction at birth.

RESULTS

The effect of growth restriction on migraine was modified by sex, with a significant association in males (p<0.001), but not in females (p = 0.20). In particular, males born VSGA were at increased risk of developing migraine (OR 2.73, 95% CI 1.63-4.58, p<0.001), with an intermediate risk among those born SGA (OR 1.50, 95% CI 0.96-2.35, p = 0.08) compared to those born AGA. There was no significant association between growth restriction and frequent TTH (p = 0.051).

CONCLUSION

Growth restriction was associated with increased risk of migraine in adulthood among males, but not among females. This suggests that migraine might, in part, be influenced by early life events, and that males seem to be particularly vulnerable.